• Yanming Ren, Lunxin Liu, Hong Sun, Yi Liu, Hao Li, Lu Ma, Chang-Wei Zhang, Xiao-Dong Xie, Min He, Chao You, and Jin Li.
• Department of Neurosurgery, West China Hospital, Chengdu, China.
• World Neurosurg. 2018 Jan 1; 109: e615-e624.

BackgroundBlood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy.ObjectiveTo review our experience with the treatment of BBAs and explore the optimal treatment strategy.MethodsA total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed.ResultsThe cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year.ConclusionsBBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.Copyright © 2017 Elsevier Inc. All rights reserved.

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